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Gao X, Ni Y, Hu W, Wang G, He X. Comparative study about the therapeutic effect of cTBS and rTMS in the treatment of auditory verbal hallucinations in schizophrenia. Postgrad Med J 2024:qgae119. [PMID: 39295243 DOI: 10.1093/postmj/qgae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/08/2024] [Accepted: 09/12/2024] [Indexed: 09/21/2024]
Abstract
OBJECTIVE This study aims to compare the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) and continuous theta-burst stimulation (cTBS) treatment in schizophrenia patients with auditory verbal hallucinations (AVHs). METHODS We enrolled 64 schizophrenia patients with AVHs who were treated with either rTMS (n = 32) or cTBS (n = 32), and we compared the clinical outcomes by evaluating parameters from motor evoked potentials, Positive and Negative Syndrome Scale (PANSS), Auditory Hallucination Rating Scale (AHRS), and MATRICS Consensus Cognitive Battery (MCCB), as well as the changes of serum neurotrophic factors before and after the treatment. RESULTS After the treatment, both treatments resulted in reduced PANSS scores, with the cTBS group showing more substantial symptom improvement across positive, negative, and general symptoms, highlighting the enhanced efficacy of cTBS. Cognitive functions assessed by MCCB also improved in both groups, with cTBS showing a generally higher therapeutic effect. Serum levels of brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) increased following treatment in both groups, with a more notable increase after cTBS, while GABA and glutamate levels remained unchanged. Cardiovascular indices were unaffected by either treatment, suggesting no significant impact on cardiovascular health. CONCLUSIONS Our study found that both rTMS and cTBS treatment can exhibit therapeutic effects in the management of AVHs in patients with schizophrenia. However, cTBS treatment generally shows a higher therapeutic effect than rTMS treatment.
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Affiliation(s)
- Xiaofeng Gao
- Psychiatry Department, The Third Hospital of Quzhou, No. 226 Baiyun North Avenue, Kecheng District, Quzhou, Zhejiang 324000, China
| | - Yanfei Ni
- Psychiatry Department, The Third Hospital of Quzhou, No. 226 Baiyun North Avenue, Kecheng District, Quzhou, Zhejiang 324000, China
| | - Weiming Hu
- Psychiatry Department, The Third Hospital of Quzhou, No. 226 Baiyun North Avenue, Kecheng District, Quzhou, Zhejiang 324000, China
| | - Guomin Wang
- Psychiatry Department, The Third Hospital of Quzhou, No. 226 Baiyun North Avenue, Kecheng District, Quzhou, Zhejiang 324000, China
| | - Xianyan He
- Psychiatry Department, The Third Hospital of Quzhou, No. 226 Baiyun North Avenue, Kecheng District, Quzhou, Zhejiang 324000, China
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Xie Y, Li C, Guan M, Zhang T, Ma C, Wang Z, Ma Z, Wang H, Fang P. Low-frequency rTMS induces modifications in cortical structural connectivity - functional connectivity coupling in schizophrenia patients with auditory verbal hallucinations. Hum Brain Mapp 2024; 45:e26614. [PMID: 38375980 PMCID: PMC10878014 DOI: 10.1002/hbm.26614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Auditory verbal hallucinations (AVH) are distinctive clinical manifestations of schizophrenia. While low-frequency repetitive transcranial magnetic stimulation (rTMS) has demonstrated potential in mitigating AVH, the precise mechanisms by which it operates remain obscure. This study aimed to investigate alternations in structural connectivity and functional connectivity (SC-FC) coupling among schizophrenia patients with AVH prior to and following treatment with 1 Hz rTMS that specifically targets the left temporoparietal junction. Initially, patients exhibited significantly reduced macroscopic whole brain level SC-FC coupling compared to healthy controls. Notably, SC-FC coupling increased significantly across multiple networks, including the somatomotor, dorsal attention, ventral attention, frontoparietal control, and default mode networks, following rTMS treatment. Significant alternations in SC-FC coupling were noted in critical nodes comprising the somatomotor network and the default mode network, such as the precentral gyrus and the ventromedial prefrontal cortex, respectively. The alternations in SC-FC coupling exhibited a correlation with the amelioration of clinical symptom. The results of our study illuminate the intricate relationship between white matter structures and neuronal activity in patients who are receiving low-frequency rTMS. This advances our understanding of the foundational mechanisms underlying rTMS treatment for AVH.
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Affiliation(s)
- Yuanjun Xie
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
- Department of Radiology, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Chenxi Li
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Muzhen Guan
- Department of Mental HealthXi'an Medical CollegeXi'anChina
| | - Tian Zhang
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Chaozong Ma
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Zhongheng Wang
- Department of Psychiatry, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Zhujing Ma
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
| | - Huaning Wang
- Department of Psychiatry, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Peng Fang
- Military Medical Psychology SchoolFourth Military Medical UniversityXi'anChina
- Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent PerceptionXi'anChina
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Thomas F, Gallea C, Moulier V, Bouaziz N, Valero-Cabré A, Januel D. Local Alterations of Left Arcuate Fasciculus and Transcallosal White Matter Microstructure in Schizophrenia Patients with Medication-resistant Auditory Verbal Hallucinations: A Pilot Study. Neuroscience 2022; 507:1-13. [PMID: 36370935 DOI: 10.1016/j.neuroscience.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
Auditory verbal hallucinations (AVH) in schizophrenia (SZ) have been associated with abnormalities of the left arcuate fasciculus and transcallosal white matter projections linking homologous language areas of both hemispheres. While most studies have used a whole-tract approach, here we focused on analyzing local alterations of the above-mentioned pathways in SZ patients suffering medication-resistant AVH. Fractional anisotropy (FA) was estimated along the left arcuate fasciculus and interhemispheric projections of the rostral and caudal corpus callosum. Then, potential associations between white matter tracts and SZ symptoms were explored by correlating local site-by-site FA values and AVH severity estimated via the Auditory Hallucinations Rating Scale (AHRS). Compared to a sample of healthy controls, SZ patients displayed lower FA values in the rostral portion of the left arcuate fasciculus, near the frontal operculum, and in the left and right lateral regions of the rostral portion of the transcallosal pathways. In contrast, SZ patients showed higher FA values than healthy controls in the medial portion of the latter transcallosal pathway and in the midsagittal section of the interhemispheric auditory pathway. Finally, significant correlations were found between local FA values in the left arcuate fasciculus and the severity of the AVH's attentional salience. Contributing to the study of associations between local white matter alterations of language networks and SZ symptoms, our findings highlight local alterations of white matter integrity in these pathways linking language areas in SZ patients with AVH. We also hypothesize a link between the left arcuate fasciculus and the attentional capture of AVH.
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Affiliation(s)
- Fanny Thomas
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France; Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB, Institut du Cerveau, CNRS UMR 7225, INSERM UMRS 1127, France.
| | - Cécile Gallea
- Movement Investigations and Therapeutics, MOVIT, Institut du Cerveau, CNRS UMR 7225, INSERM UMRS 1127, France; Université Pierre et Marie Curie, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Virginie Moulier
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France; Centre Hospitalier du Rouvray, University Department of Psychiatry, 76301 Sotteville-lès-Rouen, France
| | - Noomane Bouaziz
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France
| | - Antoni Valero-Cabré
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB, Institut du Cerveau, CNRS UMR 7225, INSERM UMRS 1127, France; Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University School of Medicine, 700 Albany Street, Boston, MA W-702A, USA; Université Pierre et Marie Curie, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Dominique Januel
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France; Université Sorbonne Paris Nord, Campus de Bobigny, 1 rue de Chablis, 93000 Bobigny
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Transdiagnostic Symptom Subtypes to Predict Response to Therapeutic Transcranial Magnetic Stimulation in Major Depressive Disorder and Posttraumatic Stress Disorder. J Pers Med 2022; 12:jpm12020224. [PMID: 35207712 PMCID: PMC8874724 DOI: 10.3390/jpm12020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/07/2022] [Accepted: 01/27/2022] [Indexed: 01/09/2023] Open
Abstract
The diagnostic categories in psychiatry often encompass heterogeneous symptom profiles associated with differences in the underlying etiology, pathogenesis and prognosis. Prior work demonstrated that some of this heterogeneity can be quantified though dimensional analysis of the Depression Anxiety Stress Scale (DASS), yielding unique transdiagnostic symptom subtypes. This study investigated whether classifying patients according to these symptom profiles would have prognostic value for the treatment response to therapeutic transcranial magnetic stimulation (TMS) in comorbid major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). A linear discriminant model was constructed using a simulation dataset to classify 35 participants into one of the following six pre-defined symptom profiles: Normative Mood, Tension, Anxious Arousal, Generalized Anxiety, Anhedonia and Melancholia. Clinical outcomes with TMS across MDD and PTSD were assessed. All six symptom profiles were present. After TMS, participants with anxious arousal were less likely to achieve MDD remission compared to other subtypes (FET, odds ratio 0.16, p = 0.034), exhibited poorer PTSD symptom reduction (21% vs. 46%; t (33) = 2.025, p = 0.051) and were less likely to complete TMS (FET, odds ratio 0.066, p = 0.011). These results offer preliminary evidence that classifying individuals according to these transdiagnostic symptom profiles may offer a simple method to inform TMS treatment decisions.
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Shukla S, Thirugnanasambandam N. Deriving mechanistic insights from machine learning and its possible implications in non-invasive brain stimulation research. Brain Stimul 2021; 14:1035-1037. [PMID: 34186249 DOI: 10.1016/j.brs.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sakshi Shukla
- Human Motor Neurophysiology and Neuromodulation Lab, National Brain Research Centre (NBRC), Manesar, Haryana, India
| | - Nivethida Thirugnanasambandam
- Human Motor Neurophysiology and Neuromodulation Lab, National Brain Research Centre (NBRC), Manesar, Haryana, India.
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Limongi R, Mackinley M, Dempster K, Khan AR, Gati JS, Palaniyappan L. Frontal-striatal connectivity and positive symptoms of schizophrenia: implications for the mechanistic basis of prefrontal rTMS. Eur Arch Psychiatry Clin Neurosci 2021; 271:3-15. [PMID: 32683527 PMCID: PMC7867561 DOI: 10.1007/s00406-020-01163-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS), when applied to left dorsolateral prefrontal cortex (LDLPFC), reduces negative symptoms of schizophrenia, but has no effect on positive symptoms. In a small number of cases, it appears to worsen the severity of positive symptoms. It has been hypothesized that high-frequency rTMS of the LDLPFC might increase the dopaminergic neurotransmission by driving the activity of the left striatum in the basal ganglia (LSTR)-increasing striatal dopaminergic activity. This hypothesis relies on the assumption that either the frontal-striatal connection or the intrinsic frontal and/or striatal connections covary with the severity of positive symptoms. The current work aimed to evaluate this assumption by studying the association between positive and negative symptoms severity and the effective connectivity within the frontal and striatal network using dynamic causal modeling of resting state fMRI in a sample of 19 first episode psychosis subjects. We found that the total score of positive symptoms of schizophrenia is strongly associated with the frontostriatal circuitry. Stronger intrinsic inhibitory tone of LDLPFC and LSTR, as well as decreased bidirectional excitatory influence between the LDLPFC and the LSTR is related to the severity of positive symptoms, especially delusions. We interpret that an increase in striatal dopaminergic tone that underlies positive symptoms is likely associated with increased prefrontal inhibitory tone, strengthening the frontostriatal 'brake'. Furthermore, based on our model, we propose that lessening of positive symptoms could be achieved by means of continuous theta-burst or low-frequency (1 Hz) rTMS of the prefrontal area.
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Affiliation(s)
- Roberto Limongi
- Robarts Research Institute, 1151 Richmond St. N, UWO, London, ON, N6A 5B7, Canada. .,Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
| | - Michael Mackinley
- Robarts Research Institute, 1151 Richmond St. N, UWO, London, ON N6A 5B7 Canada ,Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | - Kara Dempster
- Department of Psychiatry, Dalhousie University, Halifax, NS Canada
| | - Ali R. Khan
- Robarts Research Institute, 1151 Richmond St. N, UWO, London, ON N6A 5B7 Canada
| | - Joseph S. Gati
- Robarts Research Institute, 1151 Richmond St. N, UWO, London, ON N6A 5B7 Canada
| | - Lena Palaniyappan
- Robarts Research Institute, 1151 Richmond St. N, UWO, London, ON, N6A 5B7, Canada. .,Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada.
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